Therapy's DelusionsThe Myth of the Unconscious
and the Exploitation of Today's Walking Worried

by Ethan Watters & Richard Ofshepublished by Scribner, New York, 1999

reviewed by Douglas Smith

I read this book not primarily because of
the promise on the dust cover that the book "reveals how, over
the years, talk therapy has masqueraded as a scientific
discipline and has cost patients time, money, and their mental
well-being" but rather because of the claim, also on the dust
cover, that the book "makes the decisive case for the biomedical
approach to mental illness." The book succeeds admirably as
a critique of so-called psychotherapy. However, it fails
to present a convincing case for "the biomedical approach to
mental illness."
Most of the book is a criticism of
so-called psychotherapy, and most of this criticism is accurate
and justified. For example, the authors, a sociology
professor and a journalist, say the following:

"...we will show how talk therapy, in most of its forms, can
make little claim to effectively cure major mental illnesses" (p.
14).

"To seek out therapy today is to stick your hand into a grab
bag of theories that often utterly contradict each other" (p. 14)

They write of "the undeserved deference and status accorded
to psychotherapists as applied scientists" (p. 18).

"...psychoanalysis has long masqueraded as a science" (p. 23
- footnote).

"The sad truth is that there are many mental health healers
who have studied hard in the belief that they were receiving a
solid understanding of the mind and behavior. What they
often received instead, through no fault of their own, was an
education in the psychological equivalent of alchemy" (p. 25).

"...there is no agreement in the profession over what
constitutes the state of 'mental health'" (p. 33).

"What the history of the discipline shows is not only that
psychodynamic therapy has proven ineffective in treating mental
illnesses, but that practitioners have often done their patients
great harm" and "To offer someone in need a treatment known to be
harmful is unconscionable" (pages 41-42).

"...no one agrees on what psychotherapy is" (p. 129).

"In a review of forty-two studies comparing professional
therapists with paraprofessional therapists (such as teachers
given the job of counseling students), only one study showed that
the trained therapists got better results. Twenty-nine
studies showed no difference between the two groups, and the
remaining twelve studies showed that the paraprofessionals
actually outperformed the professional therapists" (p. 130).

"A clear and general understanding of therapy's effectiveness
would indeed lead to a general collapse of therapeutic authority"
(p. 136).

The authors don't dispute the value of what they call
"well-intended counseling and advice" and say "counseling
services fall largely outside our critique of psychotherapy."
But they also say "we will question whether such practice
deserves status as a mental health discipline as well as whether
it warrants our shared investment through health care
dollars [i.e., health care insurance]. We will also question whether such counseling
requires special training and certification" (p. 15). They
say: "We believe there is good reason to warn people, in
the
strongest possible language, away from explanatory theories and
treatment methods that claim respect because they are scientific
but in reality are built on myth. Similarly, if we as a
society recognize that therapy depends on faith and not proof of
its effectiveness, we may want to allocate our collectively
gathered health care resources [i.e., health care insurance]
elsewhere" (p. 235).

Almost any impartial person who believes in psychotherapy before
reading this book won't afterwards.
Odd as it may seem, on one point I disagree
with the authors of this book and agree with the psychodynamic
therapists. That is the existence of the unconscious.
The subtitle of this book is "The Myth of the Unconscious..." A
little reflection can demonstrate the existence of the
unconscious to almost anyone: Have you ever tried to
remember
someone's name and been unable to do so? Have you then - an
hour, a day, or a week later - remembered the name without
having been reminded of it? Question: Where
was your
memory of the name during the time you couldn't remember
it? It must have been in your mind somewhere or you
couldn't have remembered it later without being reminded.
The answer is it was in the unconscious part of your
mind. Similarly, important aspects of your
thinking can be forgotten, that is, can become unconscious.
For example, if you have a low opinion of yourself, you might not
remember the reason being what your parents told you when you
were young. Sometimes you can free yourself of the
consequences of such bad experiences simply by remembering
(retrieving from your unconscious) why you feel as you do.
For example, if as an adult you see how fallible (or worse) your
parents are, you may more easily discount their disparagement
when you were a child, but only after you realize where your
feelings of inferiority came from. Where I part company
with today's psychotherapists and agree with the authors of
Therapy's Delusions is I do not think trained
psychotherapists are better than anyone else at helping you with
this process.
After reading a few chapters of the
authors' critique of psychotherapy I got impatient and skipped
ahead searching for their defense of the
biomedical approach to so-called mental illness, and I found much
of it is simply wrong. For example, they say the
effectiveness of lithium for mood swings or so-called
manic-depression is "beyond doubt" (p. 212). They
overlook the fact that lithium is simply a neurotoxic
chemical that interferes with almost all neurological
function. It is not specific for so-called
manic-depression and reduces much more mental
functioning than just mood swings. They say "the atrophy of
the brain and dilated cerebral ventricles" of so-called
schizophrenics shown by magnetic resonance imaging (MRI) proves
that schizophrenia is biologically caused (page 213). They
are apparently unaware that this brain damage shown with MRI
is caused not by "schizophrenia" but by the drugs with
which so-called schizophrenics are treated!
What little I found that might have some validity appears
on a single page:

Careful doctors can test blood and find out, for example, if the
patient has higher-than-normal levels of lead, copper, or carbon
monoxide. With sophisticated tests, they can learn whether
someone is suffering the long-delayed effects of a typhus
exposure, a brain tumor, or a heart problem that is limiting
oxygen supply. Through other means they can detect thyroid
problems, sleep disorders, Lyme disease, metabolic defects, and
hundreds of possible infections, viruses, and lesions. All
of these things can cause (and are often first noticed because
of) changes in behavior and mental processing. Many of
these problems can cause symptoms of depression; others can bring
on hyperactivity or psychosis, and still others (like copper
buildup) can spark bizarre and antisocial behavior. Medical
science has treatments for all the problems mentioned above and
in many cases can effect complete cures.[p. 215]

I suspect even these assertions are questionable, mostly because
it is difficult to distinguish a person's psychological reaction
to health problems from direct neurological causes.
Generally,
biological diseases that affect the brain eliminate rather
than
cause thinking, emotions, or behavior. For example, a heart problem causing
limited
oxygen supply probably won't cause severe unhappiness
or depression, as these authors say, but will instead cause a
general loss of function, mental and otherwise - unless
the patient becomes emotionally depressed because of his awareness
of his heart problem. However, on the very next page
the authors of this book
correctly say that such bona-fide health problems "are not likely
to
be recognized by a therapist or even most
psychiatrists. ... Therapists and most psychiatrists
presented with any of the problems mentioned above will likely
never know that they are treating a patient with a curable
disease that is affecting the brain and therefore behavior" (p. 216
- italics in original). These authors bemoan "the lack of diagnostic skill on
the part of the psychiatrists in the profession" (p. 227).
As part of this criticism of psychiatry, they present an
effective and entirely justified critique of the American
Psychiatric Association's Diagnostic and Statistical Manual of
Mental Disorders or DSM. In particular, they point out
that the "diagnostic" categories in the DSM are invalid, because
to qualify as a diagnosis, the cause must be
identified, and the "diagnoses" in the DSM don't do that.
The "diagnoses" in the DSM are descriptions, not diagnoses.
I completely agree with the authors of this
book where they say "it is time for the mental health professions
to begin agreeing on the methods that are effective and to
limit their practice to those methods" (p. 236 - italics
in original). The problem is if mental health
professionals were to limit their practices to what is
truly helpful, just about all of today's biological
psychiatry and all psychotherapy other than
common-sense counselling would be discontinued, and only a
small number of today's mental health professionals could earn a
living doing that.